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Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of ischaemic cerebrovascular diseases

Liping Liu, Weiqi Chen, Hongyu Zhou, Wanying Duan, Shujuan Li, Xiaochuan Huo, Weihai Xu, Li'an Huang, Huaguang Zheng, Jingyi Liu, Hui Liu, Yufei Wei, Jie Xu, Yongjun Wang
DOI: 10.1136/svn-2020-000378 Published 18 June 2020
Liping Liu
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Weiqi Chen
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Hongyu Zhou
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Wanying Duan
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Shujuan Li
2Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Xiaochuan Huo
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Weihai Xu
3Department of Neurology, Peking Union Medical College Hospital, Beijing, China
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Li'an Huang
4Department of Neurology, Guangzhou Overseas Chinese Hospital, The First Affiliated Hospital of JINAN University, Guangzhou, China
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Huaguang Zheng
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Jingyi Liu
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Hui Liu
2Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Yufei Wei
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Jie Xu
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Yongjun Wang
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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  • Figure 1
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    Figure 1

    The management flow chart of patients with acute ischaemic stroke. CTA, CT angiography; CXR, chest X-ray; DBP, diastolic blood pressure; IV, intravenous; SBP, systolic blood pressure; TIA, transient ischaemic attack.

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    Figure 2

    Intravenous recombinant tissue plasminogen activator (IV rt-PA) administration in patients with ischaemic stroke within 4.5 hours of onset.

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    Figure 3

    Endovascular treatment in patients with acute ischaemic stroke (AIS). BP, blood pressure; mRS, modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; rt-PA, recombinant tissue plasminogen activator.

  • Figure 4
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    Figure 4

    Antiplatelet treatment in patients with acute ischaemic stroke (AIS). INR, international normalised ratio; NOAC, novel oral anticoagulant. 1Non-disabling ischaemic cerebrovascular events refer to ischaemic cerebrovascular events without significant disability sequelae, including: 1. Transient ischemic attack (TIA) 2. Mild ischaemic stroke 3.Symptoms quickly relieved without significant disability sequelae. 2High-risk events include: 1. High-risk TIA (ABCD 2≥4 points) and mild stroke with 24h within onset. 2. Acute multiple cerebral infarction 3. Intracranial or extracranial aortic atherosclerotic stenosis ≥50%.

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    Figure 5

    Management of cerebral oedema/high intracranial pressure in patients with acute ischaemic stroke. BP, blood pressure; NICU, neurological intensive care unit.

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    Figure 6

    Haemorrhagic transformation management in patients with acute ischaemic stroke. INR, international normalised ratio.

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    Figure 7

    Epilepsy management within 24 hours after stroke onset.

  • Figure 8
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    Figure 8

    Diagnosis process for unexplained embolic stroke. CTA, CT angiography; ESUS, embolic stroke of undetermined source; MRA, magnetic resonance angiography.

  • Figure 9
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    Figure 9

    Blood pressure (BP) management in patients with acute ischaemic stroke (AIS).

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    Figure 10

    Blood pressure management in patients with acute ischaemic stroke. LDL-C, low-density lipoprotein-cholesterol; TIA, transient ischaemic attack; LOR B, Class IIB Recommendation .

Tables

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  • Table 1

    Relative definitions of ischaemic cerebrovascular disease

    Relative diseaseDefinition
    Ischaemic cerebrovascular diseaseIt refers to degeneration, necrosis or transient functional loss of local brain tissue, including nerve cells, glial cells and connective fibres, due to blood supply disorder. It is one of the common clinical diseases, which is often found in the middle-aged and elderly people, and has a high disability rate and mortality rate.
    Ischaemic strokeIt refers to ischaemic necrosis or softening of local brain tissue caused by cerebral blood circulation disorder, ischaemia and hypoxia.
    Transient ischaemic attack (TIA)It refers to transient neurological dysfunction caused by focal ischaemia of brain, spinal cord or retina without acute cerebral infarction.
    Non-disabling ischaemic cerebrovascular events (NICE)It refers to ischaemic cerebrovascular diseases that do not leave neurological functional disability, including the following three groups of people: TIA, mild ischaemic stroke (NIHSS score ≤3 or ≤5), stroke that is rapidly relieved and does not leave disability. Its clinical features are usually mild symptoms or rapid and complete relief when the disease occurs, and no or only slight neurological deficits are left when the disease occurs, which does not affect daily life and work.
    Disabling ischaemic cerebrovascular eventsIt refers to ischaemic cerebrovascular events with significant disability left after onset.
    Atherosclerotic cardiovascular diseasesIt refers to various clinical diseases with ischaemic or endothelial dysfunction-inflammatory changes caused by atherosclerosis, including acute coronary syndrome, myocardial infarction, stable or unstable angina pectoris, after coronary revascularisation, atherosclerosis-induced stroke or TIA (newly added), peripheral arterial disease or after vascular reconstruction.
    • NIHSS, National Institutes of Health Stroke Scale.

Supplementary Materials

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    [svn-2020-000378supp001.pdf]

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Stroke and Vascular Neurology: 10 (1)
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Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of ischaemic cerebrovascular diseases
Liping Liu, Weiqi Chen, Hongyu Zhou, Wanying Duan, Shujuan Li, Xiaochuan Huo, Weihai Xu, Li'an Huang, Huaguang Zheng, Jingyi Liu, Hui Liu, Yufei Wei, Jie Xu, Yongjun Wang
Stroke and Vascular Neurology Jun 2020, svn-2020-000378; DOI: 10.1136/svn-2020-000378

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Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of ischaemic cerebrovascular diseases
Liping Liu, Weiqi Chen, Hongyu Zhou, Wanying Duan, Shujuan Li, Xiaochuan Huo, Weihai Xu, Li'an Huang, Huaguang Zheng, Jingyi Liu, Hui Liu, Yufei Wei, Jie Xu, Yongjun Wang
Stroke and Vascular Neurology Jun 2020, svn-2020-000378; DOI: 10.1136/svn-2020-000378
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Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of ischaemic cerebrovascular diseases
Liping Liu, Weiqi Chen, Hongyu Zhou, Wanying Duan, Shujuan Li, Xiaochuan Huo, Weihai Xu, Li'an Huang, Huaguang Zheng, Jingyi Liu, Hui Liu, Yufei Wei, Jie Xu, Yongjun Wang
Stroke and Vascular Neurology Jun 2020, svn-2020-000378; DOI: 10.1136/svn-2020-000378
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  • Article
    • Abstract
    • Introduction
    • Section 1: definitions associated with ischaemic cerebrovascular diseases
    • Section 2: emergency assessment and diagnosis of patients with ischaemic stroke
    • Section 3: reperfusion therapy for AIS
    • Section 4: antiplatelet aggregation therapy for acute ischaemic cerebrovascular disease
    • Section 5: other treatment in the acute phase
    • Section 6: general supportive care and complications management
    • Section 7: early evaluation and diagnosis of aetiology and pathogenesis of ischaemic cerebrovascular disease
    • Section 8: intervention on aetiology and pathogenesis
    • Section 9: management of risk factors and long-term intervention
    • Footnotes
    • References
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